More People Turning to Nonmedical Care Practices for Fibromyalgia and More

By Allison Bruce
for the Ventura County Star
Janet Janszen reclines on the table, rolling up her sleeves and pants legs. The room is exceptionally warm and the air carries the scent of dried herbs in the other rooms.
She relaxes as Nathan Kaehler pushes small needles into each of her ears, then does the same to her wrists, elbows, knees and legs.
Janszen undergoes acupuncture treatment about once a week in a small office building in Ojai, California. She also takes a blend of herbs to help treat pain, energy loss and lack of sleep that often affects fibromyalgia patients like her.
She is among a growing number of people who are trying alternatives to traditional medicine like painkillers to treat and prevent certain ailments. About one-third of American adults report using some form of alternative medicine, with annual out-of-pocket costs expected to exceed $27 billion this year, according to a study from the Institute of Medicine. The number of visits to alternative-care practitioners already exceeds visits to primary-care physicians.
Usually, damp days cause Janszen the most pain. But proof that the past three months spent visiting the Ojai Herb and Acupuncture Clinic have paid off is that she still runs errands and moves about during this particularly heavy rainy season, she said.
She was diagnosed with fibromyalgia about eight years ago.
"I tried many, many treatments at the beginning with my M.D. and regular Western medicine," Janszen said. "As I continued on this path, I turned to alternative approaches. Unfortunately, Western medicine -- I don't think they have a handle on it yet. Basically, they treat the symptoms. If there's pain, they give you a pain pill."
Those in the fields considered alternative, such as acupuncture, herbs, massage or chiropractic, have seen the shift.
Kaehler runs the Ojai Herb and Acupuncture Clinic and teaches at the College of Oriental Medicine in Santa Barbara. He is licensed in Chinese medicine. He said there is a slow movement away from the simple fix of popping a pill. That's a trend he likes, because it means more choices for patients and doctors.
"Doctors are more willing to talk about alternatives as part of therapy," he said.
What is becoming increasingly important is that patients tell their doctors they are using alternative medicine. The Institute of Medicine study found that less than 40 percent of people using alternative medicine tell their physician about it.
That can lead to bad drug interactions or other complications. The study recommends that doctors and patients be better educated on integrating alternative and traditional medicine.
More acceptance
Some patients said they would be more likely to discuss alternative therapy with their regular doctors if their doctors were more receptive to the idea.
Keith Rodriguez first considered chiropractic care after his regular doctor had treated him with painkillers for more than a year after he injured his back.
Sometimes, the pain was so debilitating the Oxnard resident had to take more than a month off work. He started to worry about taking so much medication and whether his work in law enforcement was being affected by his injury.
"I was at a dead-end as far as my health was concerned, as far as my back," he said. "The only other alternative to painkillers was surgery, but my situation wasn't to the point where I needed surgery."
He said his doctor wasn't concerned about the painkillers, but also wasn't open to alternatives. Rodriguez had heard from others who had seen benefits from seeing a chiropractor, so, he decided to try it.
He visited Anderson Chiropractic, which has offices in Oxnard. With treatment, he said his pain level dropped from high to very low. He has since recommended it to other people in his office. He also has a new physician.
"My heart goes out to people who are stuck with doctors and the doctors don't make any reference to alternative care," he said. "They may be rushed off to surgery when they maybe didn't need surgery. There needs to be that sense that there's somewhere else to go, other methods out there that are just as effective if not more so."
The first resort
In his 37 years as a chiropractor, Roger Anderson of Anderson Chiropractic said more doctors have referred patients to him for back pain. He said he would like to see patients consider chiropractic as the first step when they suffer from musculoskeletal pain.
"As far as pain and the spine is concerned, it should be chiropractic first, medicine second, surgery last," he said.
Many types of alternative medicine tend to be less invasive than traditional treatments. But their existence on the periphery for so long in Western medicine means they are often the last step instead of the first.
Pamela Fuller of Ventura said by the time pain sufferers see her their attitude is: "'I'll try anything.'" Fuller uses massage and Reiki, a touch therapy using energy in the body to promote healing.
Fuller acknowledges that there is skepticism about practices such as Reiki, but she points to clients who have found relief through the practice. She also is seeing more doctors looking into alternatives. At a spirituality and healing conference at Harvard, Fuller was amazed by the number of physicians, surgeons and oncologists attending.
Patients also are requesting more often that their visits be billed to their insurance companies, which pay for at least part of some alternative treatments.
Better coverage of alternative care costs is, in part, driving more people to try an alternative -- as are heightened concerns about taking some medications.
Pain medicine
When tests showed that the painkiller Vioxx was connected with increased risk of heart attacks or strokes in some patients, concern increased about the drug and similar medication classified as Cox-2 inhibitors.
Once Vioxx was pulled from the shelves, Kaehler said he had a patient come in who had been taking a similar Cox-2 inhibitor for neck and shoulder pain. The patient talked with his heart doctor about alternatives and now is taking a combination of ibuprofen, acupuncture and herbs to manage his pain.
"It's not like there's a rush, I haven't seen a huge change since this sort of press about Cox-2," Kaehler said. "It's one more thing that has kind of shifted people's awareness a little."
Dr. Gregg Hartman with Ventura Orthopedics in Simi Valley said his patients ask him about alternative medicine -- everything from acupuncture and chiropractic to magnets used for relief.
"There's all kinds of stuff out there. I don't claim to understand any of it," he said, though he stopped to say he understood the mechanisms used by chiropractors. "I'm not going to tell them not to do it. People use it and see results."
Hartman said many patients found that Vioxx was the only thing that really worked for them and they would still use it knowing the risks if they could still get it. A U.S. Food and Drug Administration panel recently recommended that the drug be put back on the market with a warning for patients about some of the inherent risks.
Patients should be allowed to make informed decisions, Hartman said.
"You have to be aware of the side effects and watch for them and check for them and advise patients so they can make the decision best for them based on the information," he said.
Todd Anderson, son of Roger and a chiropractor, saw the removal of Vioxx as a way to entice more people to try alternative medicine, placing an advertisement in the paper talking about pain management. And he recently hired a licensed acupuncturist and brought in other alternatives to the practice. People need options, he said.
"No health practitioner has the corner on the market for being the most appropriate course of treatment," he said.
Responsible health
Roger Anderson said the biggest shift that will drive alternative medicine is yet to happen. People still go to the doctor for what he calls "sickness care" more than "health care." Alternative medicine will grow even more when people start thinking of it as part of prevention, rather than a last-ditch effort toward feeling better once they're already sick.
"If you're going on cholesterol medication, you also need to change your diet," he said.
Janszen, Kaehler's patient, also recognizes the importance of patients taking personal responsibility for their health.
"People come to either Nathan or a doctor and expect to be fixed without taking responsibility for their own lives," she said.
She said fibromyalgia led to re-examining her high-stress corporate job and moving to a career that focused on her photography and writing. She also kept track of what helped her the most, such as swimming and exercising in warm water and walking.
"You have to be very disciplined," she said. "Those days you don't feel well are the days when it's most important to get in the warm water and exercise."
Janszen said she would like to see more acceptance of alternatives that could lead to the use of the different forms of medicine in complementary ways.
Regulation
The Institute of Medicine report recommended more regulation and study of alternative and traditional medicine using the same standards to determine the effectiveness of a treatment. It also recommends more regulation of dietary supplements -- which are treated as food, not drugs.
Todd Anderson welcomes more study of both alternative and traditional medicine. He is confident that the data from studies of chiropractic manipulation on lower back pain would stand up well against other forms of treatment.
Kaehler supports more regulation, particularly of dietary supplements and traditional medicines, such as the Chinese herbs he prescribes.
There are a lot of pills and herbs that people self-prescribe, sometimes leading to problems.
"For many people, it's a difficult line to realize where they can self-prescribe and where they're getting in over their heads," he said. "It's quite different from just taking a multivitamin."
He wants to see more recognition and regulation of herbs and how they are handled.
"It would give the public more assurance in certain ways of safety and would also provide (a higher) level of credibility," he said. "It's a tricky thing to work out, but in the long run, going in that direction is good."
On the Web:
http://www.iom.edu
http://nccam.nih.gov
Source: Ventura County Star (online)